Nurse Shajaira Powell-Bailey measures out a vaccination at a Florida elementary school. Vaccines, not as effective this year against circulating strains, are still the best defense, the state health department and CDC say.

The cost common flu strain this year in Colorado is influenza A, or H3N2 virus, which is a severe one.

It is known to lead to more hospitalizations and deaths than other strains, according to the state health department, especially among the elderly, young children and people with certain chronic medical conditions.

“We tend to have more severe seasons when H3N2 viruses predominate,” Dr. Lisa Miller, state epidemiologist at the Colorado Department of Public Health and Environment said in a recent release.

Reported influenza hospitalizations and outbreaks in long-term care facilities in Colorado increased in early December. There were 24 outbreaks by Dec. 6.

The health department said the best defense in getting a flu vaccine. Even though, this this year, it won’t be as effective. About half of the H3N2 viruses circulating are different from those included in this season’s vaccine, the Centers for Disease Control and Prevention reported. Viruses change and present a moving target for virologists.

Besides getting a flu shot, the health department says, cover coughs and sneezes, stay away from sick people and wash hands often. “If you’re sick, stay home from work or school so you don’t spread the virus to others,” the health department advises.

For the week ending December 6, influenza activity continued to increase. State
laboratory surveillance shows that almost all influenza viruses currently circulating in Colorado are the H3N2 virus, the health department reports.

There were 153 additional hospitalizations reported during the most recent week for which data are available (compared to 57 the previous week ending Nov. 29). Of these reported cases, 51 were from the previous week and 102 were new.

The state’s cumulative total is 248 hospitalizations in 23 counties.

Update: An influenza-associated death of a child was confirmed in Larimer County Monday, Dec. 16. An 18-month-old Loveland girl died from the flu at McKee Medical Center Dec. 9.

CDPHE surveillance for the 2014 –2015 influenza season officially began on September 28 and will run through May 23. Current surveillance activities include: reporting of hospitalizations due to influenza, reporting of influenza-like illness
visits by selected sites, reporting of influenza testing activity by sentinel hospital labs, monitoring circulating influenza viruses through molecular typing at the state public health laboratory, outbreaks of influenza in long-term care facilities (LTCF), and reporting of pediatric deaths due to influenza.

This undated photo provided by Arapahoe Basin Ski Area in Colorado shows a group of children practicing their ski moves with an instructor.(AP Photo/Arapahoe Basin Ski Area, Dave Camara)

Colorado is the eighth healthiest state, according to United Health Foundation’s annual health rankings, released Dec. 10.

The index ranks Colorado as the least obese state, and No. 1 both in physical activity and low diabetes prevalence.

Colorado ranked second in having the lowest rate of cardiovascular deaths and ranked third lowest in cancer deaths.

Still, it loses out to seven other states, in this order: Healthiest Hawaii, Vermont, Massachusetts, Connecticut, Utah, Minnesota and New Hampshire.

The three main factors dragging down our ranking: prevalence of binge drinking, low birth weights and the large disparity in health status between highly educated and less educated Coloradans.

Gov. John Hickenlooper said in a press release, “As Coloradans, we know this state is a lean, mean, working-hard, playing-hard healthy machine. Well, not mean, but you get the idea. I’m not surprised we’re the least obese state and No. 1 in physical activity. Now, let’s keep the body moving and become the healthiest state.”

Dr. Larry Wolk, chief medical officer at the Colorado Department of Public Health and Environment, said: “Many factors contribute to having a healthy state, from our vibrant economy and people who value outdoor recreation, to the contributions of many state and local public health partners that focus on keeping Coloradans healthy.”

“With a low prevalence of chronic diseases, such as obesity and heart disease, we are able to focus our attention on prevention. The result will be spending less money on health care while improving our quality of life and longevity. Colorado should be proud of its culture of promoting good health,” said Chris Wiant, chief executive of the Caring for Colorado Foundation.

“One area where we hope to see significant improvement is in lowering Colorado’s rate of whooping cough. In the past year we saw a 256 percent increase in whooping cough, or pertussis, cases, ” Dr. Wolk said.

In October 2012, the state health department declared a pertussis outbreak when Colorado surpassed 1,000 cases. As of Nov. 15 this year, the state has 1,161 pertussis cases, despite vaccination being an effective tool against pertussis.

The Colorado Consumer Health Initiative Wednesday launched a new website,“Covered U,” to help the newly insured navigate how and where to find health care services.

CoveredU.org is a tool that community-based health groups and Connect for Health Colorado guides could use to help educate health care consumers on buying and using health insurance, CCHI says.

“Now that Coloradans can sign up for health insurance again under open enrollment, it’s important that they not only know how to buy the best plan for their health care needs, but also know how to use that insurance,” Adam Fox, CCHI director of strategic engagement, said in a press release. “The interactive website will allow consumers to compare their health care choices and costs in basic scenarios and identify what kind of coverage might best suite them.”

Users can either select either “How to USE your health insurance” or “How to SHOP for health insurance.” The section on using insurance offers “choose your own adventure” style medical scenarios, such as sick, cut or appendicitis, and shows options for provider locations, such as doctor’s office, urgent care center or emergency room. It gives a cost estimate for each choice.

“The big news is that almost everyone will be able to get health insurance through Connect for Health Colorado,” said CCHI’s Fox. “But a big part of health insurance is how and where somebody accesses care. Now it’s easy to get the guidance they need to use their health insurance most appropriately and most affordably.”

A Nov. 11 survey by the Kaiser Family Foundation found many Americans with less education, younger people and the uninsured do not understand how to most effectively use health insurance.

Jennifer Perkins, second from left, a broker from The Jen Perkins Agency, and Rachel Gips, second from right, a guide from the GLBT Community Center of Colorado, try to help customers as they figure out their options for health insurance. In the final week leading up to the March 31, 2014, deadline for signing up for health insurance through the Affordable Care Act. (Kathryn Scott Osler The Denver Post)

Connect for Health Colorado, the state health insurance marketplace, is touting its new and improved enrollment website for customers shopping for private health insurance.

Open enrollment under the Affordable Care Act begins Nov. 15 and runs through Feb. 15, 2015.

More than 148,000 individuals are covered through plans purchased on the Marketplace in 2014.

All this week, customers could compare policies offered in their area, research eligibility for tax credits, choose coverage and begin the enrollment process.

“We want to encourage consumers to comparison shop for policies that meet their needs and their own particular circumstances,” said interim CEO Gary Drews. “Monthly premiums, benefits and the financial assistance available to consumers who qualify can change each year. This year, there are some new, less expensive choices available in many regions. We are urging Coloradans to be smart consumers – and compare their options before renewing their current plan or enrolling in a new one.”

Applicants this year can use a single application process directing consumers to either complete enrollment in private health insurance through Connect for Health Colorado or with Medicaid with the state Department of Health Care Policy and Financing.

During open enrollment, other new features will roll out as ready including:

An Avatar/Guide named “Kyla,” a virtual assistant who can help customers through some key steps of the enrollment process.

A Medication Look-Up Tool, or formulary, which lets customers compare prescription coverage under various policies.

A Provider Directory to help customers check whether their doctor is in the network of a health plan.

Whether renewing or enrolling for the first time, exchange customers must complete enrollment by Dec. 15 to have coverage Jan. 1, 2015, and avoid a gap in insurance.

Heather Carson, an emergency room nurse at Henry Mayo Hospital in Valencia, wears stickers with names of the two Texas nurses infected with the Ebola virus, after she and other members of the California Nurses Association and National Nurses United met with Gov. Jerry Brown to discuss the Ebola crisis, Tuesday, Oct. 21, 2014, in Sacramento, Calif. The Nurses unions, which have highly critical of the response so far, say they want California to be the national leader in enacting the highest Ebola safety standards. (AP Photo/Rich Pedroncelli)

The Denver Post heard from several Kaiser Permanente patients this week who were taken aback to be asked about Ebola, when calling to schedule a wellness visit, mammogram or other routine exam or procedure. They were asked if they had traveled to an Ebola-affected area or been in contact with any suspected Ebola patients.

The Colorado Department of Public Health and Environment recently launched its “Ebolas: Facts, not fear,” campaign. Was the Ebola questioning of every Kaiser patient, not just those with flu-like or Ebola-like fevers or symptoms, overkill or reasonable? We asked the health department.

It turns out a better slogan might be, “Better safe than sorry.”

CDPHE chief medical officer Dr. Larry Wolk said: “We appreciate efforts of all health care providers to help keep Coloradans safe by asking patients about their travel history and symptoms.”

The CDPHE’s guidelines for health-care providers can be summarized as “Ask! Isolate. Call us.”

“Ask (apparently everybody) about travel to Sierra Leone, Guinea and Liberia in West Africa in the past 21 days.”

“If travel or exposure criteria are met, and the person has symptoms of Ebola, place the person in a private room.” Close the door. And use the Centers for Disease Control and Prevention’s rigorous revised guidelines for personal protective equipment — no skin exposed.

Call us: Notify the hospital’s leaders and call the CDPHE, 303-692-2700, or after hours, 303-370-9395. State health officials will notify the CDC, if warranted.

In this Sept. 18, 2014, photo, Jason Prosser picks up his son Zachary, 3, from day care, in SeaTac, Wash. Prosser and his wife are one of many middle-class couples struggling with accelerating costs for critical services such as health care and housing. At the same time, their income has been stagnant for the past three years. (AP Photo/Ted S. Warren)

Consumer Reports magazine isn’t trying to incite a riot, I don’t think. Yet the leading consumer publication is trying to light a fire under consumers.

“This country’s exorbitant medical costs mean that we all pay too much for health insurance,” the report states. “Overpriced care also translates into fewer raises for American workers. And to to top it off, we’re not even getting the best care for out money.”

Wake up and smell the *$@!*coffee, America!

The report doesn’t really tell us things we don’t know. Your health insurance doesn’t always protect you, it says. Not exactly a revelation for most of us. It gives a spine-chilling example of patients hit with unexpected costs. No one bothers to tell a woman receiving a heart transplant at a hospital in her insurance carrier’s network that the surgical teams at the hospital wasn’t in network. A nasty $70,000 surprise. I would need another transplant after that.

Oak Hills Terrance Executive Director Rick Gabehart, left, shows Air Force veteran Vance Brown, 96, of Tyler, Texas, right, a North American F-100A Super Sabre “Hun” airplane at the Historic Aviation Memorial Museum in Tyler, Texas Thursday, Sept. 11, 2014. Heart to Heart Hospice, where Brown is a patient, and Oak Hills Terrace Memory Care in Tyler, where Brown is a resident, held the event to celebrate Brown’s service to the United States with his family. Brown was an Air Force Crew Chief during World War II. (AP Photo/The Tyler Morning Telegraph, Sarah A. Miller)

The end might not be near, but it is coming for each of us. And the end of life in America’s health care system is fraught with unnecessary difficulties.

“What’s most broken with out current system is how poorly designed it is to take care of people near the end of their lives, ” Dr. Jean Kutner said in an interview with The Denver Post Sept. 23.

Kutner, a professor of medicine at the University of Colorado School of Medicine, was on the panel that wrote the report. She’s also president of the American Academy of Hospice and Palliative Medicine.

“Right now it’s incredibly difficult to do the right thing for people,” Kutner said.

America is coming to terms with its demographics — the increasing number of older Americans with “some combination of frailty, physical and cognitive disabilities, chronic illness and functional limitations,” the report says.

But there is a real mismatch, the report continues, between the services people need and the services they can get.

This gap exists partly because there are few trained specialists and too few other clinicians with basic competence in palliative care — care that improves the quality of life of patients and their families facing life-threatening illness. Palliative care seeks to prevent and relieve suffering by assessing the patients’ real needs, including medical, psycho-social, spiritual, financial and so on. Hospice, for people with a terminal illness, also is comprehensive, supportive socially and focused on reducing pain and comforting the patient.

It is holistic care in a health care system that typically offers fragmented services and perverse financial incentives for care providers, the report states. End-of-life care is too often costly “technologically elaborate, medically centered interventions,” the report says.

The Institute of Medicine recommends that “integrated, person-centered, family-oriented and consistently accessible care near the end of life be provided by health care delivery organizations and private health insurers.” But there are barriers to this care, including a past lack of training for clinicians in how to provide it. And holes in insurance coverage present a major hurdle.

“There is not a well-defined way to pay for this care,” Kutner said.

Finally, more patients and families need to be involved with medical staff in advance planning and decision making. Patients need to elevate their expectations of health care providers, the report says.

“People don’t even know their options,” Kutner said. “But it should be all about choice. It’s about individualizing a care plan. It’s not about pushing people down a certain path.”

Despite the shortcomings, Kutner said, there’s been tremendous progress in the fields of hospice and palliative care in recent years. It’s been available as a board-certified specialty since 2008. Roughly two-thirds of hospitals with more than 50 beds now offer some form of palliative care and hospice.

“Colorado has one of the highest percentages of hospitals offering this care,” Kutner said. “If you look at a national scorecard, Colorado looks pretty good.”

LITTLETON, CO – JUNE 10: Soaking up the sun at the swim beach at Chatfield State Park in Littleton. ( Photo by Helen H. ichardson/The Denver Post)

Americans can’t seem to take this seriously.

Even though there has been widespread education about sun safety, and skin cancer is mostly preventable, diagnoses and deaths continue to increase.

So much so, the Surgeon General recently outlined a national action plan to re-energize the fight against skin cancer.

Five million people are treated for skin cancer each year at a cost of $8 billion. Sun worshiping is a big public health problem.

So stop sunbathing. Use protection outdoors that include sunscreens, sunglasses and hats. Don’t use indoor tanning beds, the acting U.S. surgeon general, Adm. Boris Lushniak, warned in a report released in late July.

“The number of Americans who have had skin cancer at some point in the last three decades is estimated to be higher than the number for all other cancers combined, and skin cancer incidence rates have continued to increase in recent years,” the report states.

Lushniak cited a 200 percent jump in deadly melanoma cases since 1973. Melanoma is responsible for the most deaths of all skin cancers, he said, with nearly 9,000 people dying from it each year. About $3.3 billion of skin cancer treatment costs are attributable to melanoma.

He said state and local officials need to do more to help people shelter from the sun by providing more shade at parks and sporting events.

“The Call to Action focuses on reducing UV exposure, with an emphasis on addressing excessive, avoidable, or unnecessary UV exposures (such as prolonged sun exposure without adequate sun protection) and intentional exposure for the purpose of skin tanning (whether indoors using an artificial UV device or outdoors while sunbathing).”

This is a running blog on The Daily Dose listing the latest recalls of food, dietary supplements and other health or beauty products reported by the Colorado Department of Public Health and Environment. Check here for frequently updated recall news.

FDA analysis confirmed the presence of DMAA, which is 1,3-dimethylamylamine, also called methylhexanamine, or geranium extract.

DMAA is commonly used as a stimulant, pre-workout, and weight-loss ingredient in dietary supplement products. The FDA has warned that DMAA is potentially dangerous as it can narrow blood vessels and arteries, which can cause a rise in blood pressure or other cardiovascular problems, such as shortness of breath, arrhythmia, tightening in the chest and heart attack.

Distribution: RegeneSlim is purchased by and distributed through a direct sales force within the United States and Puerto Rico, and through online sales, for both personal consumption and retail sales.

Jaxson Doolin, 6, carries full backpacks to storage Aug. 9 at Element Church in Cheyenne. Volunteers packed 2,000 backpacks full of school supplies for the Back 2 School Bash Saturday at 10 a.m. at Lions Park. Blaine McCartney/staff

In making those back-to-school lists, don’t forget the pediatrician.

Think About It Colorado, a nonprofit consumer awareness group, is advocating that a child have an annual physical exam, even if not required by the child’s school.

Unlike a visit to the doctor for a fever or other acute illness, the annual exam provides more time for physician and family to address any concerns or questions about growth and development.

“As children get older, it’s more important for them to bond with their doctor and feel like they can trust (him or her),” Think About It Colorado said in a statement. “It’s also a good chance for the provider to address important questions, especially with teenagers, including adolescent issues of drinking, smoking, drugs, sexual activity and depression.”

Think About It Colorado advises that, before a visit to the doctor:

1. Compile your child’s medical history, including vaccinations, allergies, health problems and the dates of any surgeries or hospital visits.

2. Update the family history with any changes since the last visit, such as any deaths or serious illnesses of close family members, including brothers, sisters, grandparents, aunts and uncles.

3. Make a list of your child’s medicines and amounts taken, including prescriptions, over-the-counter meds, vitamins, herbs and other supplements.

4. Also keep a running list of any questions you have had about your child’s health in the past year.

Electa Draper is the health writer for The Denver Post and has covered every news beat in a 22-year journalism career at three newspapers. She has a bachelor's degree in biology and a master's in journalism.